"When child psychiatrists gather, presentations on ADHD almost always orbit around the use of stimulants- methylphenidate and amphetamine in their many formulations. At this year's Texas Society of Child & Adolescent Psychiatrists meeting, I decided to flip the script and devote a presentation to the less celebrated options: the non‑stimulants. That choice reflects the changing prescription landscape. Stimulants still account for roughly 90 percent of all ADHD scripts, but from 2019‑2023 the annual fills for non‑stimulants climbed by about 60 percent, triple the growth rate of stimulants."
"Why? Rising concern about misuse, an uptick in co‑morbid anxiety and tic disorders, supply‑chain hiccups that left pharmacy shelves bare, and a steady stream of new data nudging clinicians to look beyond the usual suspects. Think of the difference this way: Stimulants are the medical equivalent of a double espresso, fast, powerful, and familiar. Non‑stimulants are more like a matcha latte: still energizing, but gentler, longer acting, and unexpectedly sophisticated once you develop a taste for it."
Stimulants still supply roughly ninety percent of ADHD prescriptions, while non‑stimulant annual fills rose about sixty percent from 2019 to 2023. Drivers include concerns about misuse, rising co‑morbid anxiety and tic disorders, pharmacy supply‑chain disruptions, and accumulating evidence supporting alternatives. Non‑stimulants can be prescribed alone or layered with stimulants to extend evening coverage and reduce sleep or appetite disruption. Atomoxetine is FDA‑approved for children and adults, blocks the norepinephrine transporter, is unscheduled, has slower onset, and provides roughly twenty‑four‑hour coverage without appetite or sleep side effects. Repetitive transcranial magnetic stimulation is an emerging non‑pharmacologic adjunct that may improve attention and impulsivity.
Read at Psychology Today
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